images in insuffi ciency fractures of the sacrum · sacral fractures. 1 2 these changes in signal...
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BMJ Case Reports 2011; doi:10.1136/bcr.12.2010.3630 1 of 3
DESCRIPTION We describe a case of three middle-aged women with acute-onset low back pain. Clinical examination was not contributory. Plain radiographs of the pelvis were normal in two patients ( fi gures 1 and 2 ) and showed signs of sacro-iliitis in one patient ( fi gure 3 ). Subsequently, we performed MRI, which revealed unilateral insuffi ciency fractures of the sacrum in all patients ( fi gures 4 – 6 ).
Insuffi ciency fractures of the sacrum occur when normal stresses are placed on bones with reduced mineral con-tent and elastic resistance. 1 Most fractures occur in older patients, especially women. Predisposing factors include osteoporosis, rheumatoid arthritis, prolonged glucocorti-coid treatment, pelvic radiotherapy and metabolic bone diseases. Clinical presentation is not specifi c and highly variable. 1 2
Plain radiographs are usually not diagnostic because sac-ral lesions are often obscured by bowel gas. 2 3 Bone scin-tigraphy is a sensitive technique, but the classical H-sign, consisting of fractures of both the sacral ala and a horizon-tal fracture of the sacral body, is present in only 32% of scintigraphies. 3 Because of various incomplete patterns, it is diffi cult to distinguish fractures from sacroiliitis, osteomy-elitis or metastatic bone disease. MRI is sensitive to changes in signal from bone marrow oedema that results from
Images in...
Insuffi ciency fractures of the sacrum
Dorien Joosen, Marie-Cecile Jacobs, Ron de Nijs
Maxima Medical Centre, Eindhoven, The Netherlands
Correspondence to Dorien Joosen, [email protected]
Figure 2 Plain radiograph of patient 2. Figure 1 Plain radiograph of patient 1.
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sacral fractures. 1 2 These changes in signal are, however, not specifi c and the lesions can be misinterpreted as metastatic disease. 2 3 CT may be helpful in confi rming the diagnosis and can exclude infl ammatory and malignant processes. 2 3 In our three patients, diagnosis could be made by MRI. Competing interests None.
Patient consent Obtained.
REFERENCES 1. Tsiridis E, Upadhyay N, Giannoudis PV . Sacral insuffi ciency fractures: current
concepts of management . Osteoporos Int 2006 ; 17 : 1716 – 25 .
2. Blake SP, Connors AM . Sacral insuffi ciency fracture. Br J Radiol
2004 ; 77 : 891 – 6 .
3. Schindler OS, Watura R, Cobby M . Sacral insuffi ciency fractures. J Orthop
Surg (Hong Kong) 2007 ; 15 : 339 – 46 .
Figure 3 Plain radiograph of patient 3 showing signs of sacroiliitis on the right site.
Figure 4 MRI image of patient 1 showing an unilateral (left) insuffi ciency fracture of the sacrum.
Figure 5 MRI image of patient 2 showing an unilateral (left) insuffi ciency fracture of the sacrum.
Figure 6 MRI image of patient 3 showing an unilateral (right) insuffi ciency fracture of the sacrum.
on 27 August 2020 by guest. P
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BM
J Case R
eports: first published as 10.1136/bcr.12.2010.3630 on 12 May 2011. D
ownloaded from
BMJ Case Reports 2011; doi:10.1136/bcr.12.2010.3630 3 of 3
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Joosen D, Jacobs MC, Nijs R. Insuffi ciency fractures of the sacrum. BMJ Case Reports 2011;10.1136/bcr.12.2010.3630, date of publication
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on 27 August 2020 by guest. P
rotected by copyright.http://casereports.bm
j.com/
BM
J Case R
eports: first published as 10.1136/bcr.12.2010.3630 on 12 May 2011. D
ownloaded from